Buttock pain may arise from a number of local structures in the buttock or can be referred from the lumbar spine or sacroiliac joint (SIJ), which happens quite commonly. Trigger points are common sources of referred pain to both the buttock and posterior thigh. A deep, aching, diffuse pain, which is variable in site, is an indication of referred pain. Buttock pain associated with low back pain suggests lumbar spine abnormality. Buttock pain associated with groin pain may suggest SIJ involvement.

Causes:

The cause is dependent on the area of pain, but can include:

the tendinopathy at the origin of the hamstring muscles or ischiogluteal bursitis (inflammation of a bursa in the gluteal area) if pain is constantly localised to the ischial tuberosity area (the bone in your pelvis in which you sit on)

the piriformis muscle if pain is higher up and located more on the inside of the hip joint

the buttock region itself if pain is localised in a precise area in the buttock

the gluteus medius

The gluteus medius and piriformis muscles are two of the most common sites at which trigger points develop, and commonly the cause of pain is shortening of these muscles. Occasionally, this may lead to a sciatica-like symptom, with pain radiating down the leg. This is because the sciatic nerve runs underneath the piriformis muscle, and if this muscle is tight, it may compress/pressurize the nerve, causing radiation of pain down the leg where the nerve runs through. This condition is called “piriformis syndrome” (piriformis impingement).

Treatment:

Physiotherapy treatment may will vary depending on the condition, but may include:

stretches of the muscles

electrotherapeutic modalities

soft tissue therapy (massage, soft tissue release)

core stability training

a rehabilitation exercise program to improve the overall control of the lumbopelvic area

low back mobilisation or manipulation techniques to restore full mobility to stiff intervertebral segments (if buttock pain is thought to be referred from the lumbar spine)

dry needling may be used to treat chronic muscle thickening both around the lumbar vertebrae and in the gluteal region